Pregnancy outcome of IVF/ICSI-ET in elderly patients with polycystic ovary syndrome
10.3760/cma.j.cn101441-20210318-00135
- VernacularTitle:高龄多囊卵巢综合征患者IVF/ICSI-ET助孕结局研究
- Author:
Xiaoxiao NI
1
;
Ying WANG
1
;
Yizhi YAN
1
;
Rui YANG
1
;
Linlin WANG
1
;
Lixue CHEN
1
Author Information
1. 北京大学第三医院生殖医学中心，北京 100191
- Publication Type:Journal Article
- Keywords:
Polycystic ovary syndrome;
Reproductive technologies, assisted;
Fertilization in vitro;
Embryo transfer;
Pregnancy outcome;
Elderly
- From:
Chinese Journal of Reproduction and Contraception
2022;42(10):1046-1057
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To study the effect of in vitro fertilization/intracytoplasmic sperm injection and embryo transfer (IVF/ICSI-ET) on ovarian responsiveness during ovulation induction and pregnancy outcome in elderly patients with polycystic ovary syndrome (PCOS). Methods:A retrospective cohort study was conducted, and 201 elderly women with PCOS who underwent IVF/ICSI for the first time in the Reproductive Medical Center of Peking University Third Hospital from January 1, 2016 to December 31, 2018 were selected as PCOS group. According to the 1∶1 matching principle, selected 201 elderly patients with non-PCOS menstrual regularity who entered the cycle at the same time as the elderly PCOS patients and underwent IVF/ICSI for the first time due to tubal factors alone named control group. The first three thawing cycles of this egg retrieval cycle were selected. Due to the higher incidence of ovarian hyperstimulation syndrome and the number of aging PCOS patients undergoing embryo freezing, the thawing cycles of the elderly PCOS patients were more than those of control group. A total of 215 cycles in PCOS group and 124 cycles in control group were used to analyze the clinical data and IVF/ICSI laboratory data.Results:1) Between PCOS group and control group, anti-Müllerian hormone (AMH) and antral follicle count (AFC) were significantly different [(7.66±4.62) μg/L vs. (1.89±1.44) μg/L, P=0.005; 26.44±8.06 vs. 9.33±4.05, P<0.001]; the rate of high-quality embryos in PCOS group was higher than that in control group [58.04% (1281/2207) vs. 57.20% (743/1299), P=0.005]. 2) The dosage of gonadotropin (Gn) used during ovulation induction in PCOS group was less than that in control group [(2 090.17±909.74) U vs. (2 969.14±1 101.79) U, P=0.009], but the number of oocytes retrieval was more than that in control group (15.17±8.35 vs. 9.51±5.83, P<0.001). The clinical pregnancy rate, the miscarriage rate, the ectopic pregnancy rate and the cumulative live birth rate of PCOS group were not significantly different from those of control group (all P>0.05). 3) Age, body mass index (BMI), testosterone level, ovulation stimulation program and the number of transferred embryos were the independent influencing factors of the clinical pregnancy rate ( P=0.028, P=0.004, P=0.027, P=0.014, P<0.001); BMI and the number of transferred embryos were the independent influencing factors of the live birth rate ( P=0.008, P<0.001). Conclusion:1) Elderly PCOS patients have higher follicle reserve. 2) The cumulative live birth rate can more truly reflect the fertility window of elderly PCOS patients. The cumulative live birth rate of elderly PCOS patients is significantly better than that of control group with the increase of age; the reproductive window of PCOS patients is longer than that of non-PCOS patients. 3) For elderly patients, the laboratory results should be improved as soon as possible, the waiting time in the early stage of the IVF/ICSI cycle should be shortened as much as possible, and assisted reproductive treatment should be performed as soon as possible to obtain better pregnancy outcomes.
